Cardiac Arrest due to Hyperkalemia following Intravenous Penicillin Administration

¹ Division of Circulatory Diseases, University of Tennessee College of Medicine, Memphis

Two episodes of cardiopulmonary arrest occurred after the rapid intravenous administration of potassium penicillin G in a 60-year-old black woman with streptococcal endocarditis and sepsis. Asystole, ventricular fibrillation, and atrioventricular block suggested a positive relationship of these abnormalities to the rapid change in concentration of serum potassium produced by the injections. The fact that 1 x 10⁶ units of potassium penicillin G contain 1.7 mEq K+ suggests that caution should be employed in the rapid intravenous administration of this antibiotic even in patients with normal serum electrolytes and a normal electrocardiogram.